POISOKOUS FUNGI 697 to a height of about four to six inches in woody places. It has a hollow stalk with a prominent bulb at the base, the upper margin of which is formed into a vulva or cup. The pileus is usually white but may vary in colour from pale dull yellow to olive, and has gills covered with white spores on its under surface. The fungus is a powerful poison and con- tains two active principles, amanita, Tioemo- lysin (Phallvn of Kobert) and amanita. toxin. ^ Amanita hsemolysin is a hsemolytic glycoside which is precipitated by alcohol and is completely destroyed when heated to 70 °C., or when digested with pepsin as well as pancreatin. Amanita toxin is the chief poisonous principle which is not a glycoside nor an alkaloid, but it is a nitrogenous sub- stance and is dissolved by alcohol, but is not destroyed by heat or digestive ferments. Symptoms. These are divided into two groups, irritant and neurotic. 1. Irritant Symptoms. The symptoms are usually delayed for six to ten hours or for thirty hours in some cases. These are con- striction of the throat, burning pain in the stomach, nausea, painful retchings, vomit- ing, and diarrhoea, the stools containing blood ; the urine may contain blood and albumin. These are followed by cyanosis, small pulse, laboured respirations, convul- sions, profuse sweating, collapse and death. Sometimes there may be anuria. 2. Neurotic Symptoms. These are giddi- ness, headache, mental excitement, delirium, diplopia, contraction of the pupils, tetanic spasms, insensibility and coma. In some cases irritant symptoms may be TKŤ top A*Ť^ TVT,,*^ Fig. 192.-Amamta Muscana. present, and in others neurotic only. The predominance of one or the other group of symptoms depends on the nature of the active principles present. Fatal Dose. Uncertain. Four grains and a half of rnuscarine administered hypo- dermically would prove fatal to an adult. One-third of the pileus (top) of Amanita phalloides has caused the death of a child. Fatal Period. Death usually occurs within twenty-four hours but may sometimes take place in from three to eight days. Treatment. Evacuate the stomach by giving common salt as an emetic or by lavag- ing it with water containing potassium permanganate or finely powdered charcoal. Give castor oil or magnesium sulphate to clear the bowels. Atropine is considered a physio- logical antidote to muscarine, and should be administered hypodermically. Morphine may be administered hypodermically to relieve pain. Give stimulants and normal saline subcutaneously. Repeated intravenous infusions of 300 to 500 cc. of 10 to 20 per cent sugar solutions with eventual addition of calcium salts are considered very useful. Injections of insulin combined with vitamin K and vitamin B and a ten per cent solu- tion of calcium gluconate may be administered parenterally with advantage, Anti- phaHinic serum should be used, if available. Limousin and Petit55 recommend the administration, of the fresh stomach and brain, of a rabbit in poisoning by Amanita phalloides. A family of four persons partook of A. phalloides, and one died. The other three had serious symptoms. They were given each three fresh rabbit stomachs mashed and some fresh brains, and a rapid recovery ensued. Post-mortem Appearances. Signs of inflammation of the mucous membrane of the alimentary canal are present, if irritant signs have been predominant. Fatty degenera- 54. Ford, Brit. Med. Jour., Dec. 1, 1906, p. 1541. 55. Bull, de V Acad. Med., May 1932, p. 24; Med. Annual, 1933, p. 500.